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HomeMy WebLinkAbout030-1089-40-000 CROIX COUN'T'Y ZONING DEI'AR'I'MEN'I' __ -- AS BUILT SANI'T'ARY RLI OR'I' Owner r Address ' City /State S r C pg9 -� Legal Description: a � I c TY Lot Block Subdivision/CSM 11 Sce. TAN -RAW, Town of PIN # ®.3rr- io9D- =�o -cam SEPTIC TANK - CHAMBER - HOLDING 'PANIC INFORMATION: Tank manufacturer A Size ST/PC / / Setback from: House 45 - Well Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: ., g a Width /9 Length Number of Trenches Setback from: House � Well r _ P/L, , � _ Vent to fresh air intake ELEVATIONS: Description of benchmar ,;, �& �� � ®� Elevation Description of alternate benchmark Elevation Building Sewer 7 7 ST/HT Inlet q ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () () ( ) Bottom of System( Final Grade ( Date of installation,1 P rmit num�cr O State plan number Plumber's signature License number, 1 Date o %3/ 9� Inspector(t complete rio( pion Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM C untyST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) sanitaryhr{�itf9-: Personal information you provice may be used for secondary purposes [Privacy s.15.04 (1)(m)). 77 VV 6L 4000 Permit Holder's Name: fl�ity f1�/3g� Town of: State Plan ID No.: CRAY , DAN - S � l .GG tt'' CST BM Elev.: Insp. BM Elev.: BM Description: _ Parcel &Ib0. :1089 - 40 TANK INFORMATION ELEVATION DATA A9800438 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se tic 1000 Benchm k '1.3g o3.7 ?b• ,w Dosing Aeratio Bldg. Sewer ZZ Holding I t j I t Inlet $ •$ 7 ��. TANK SETBACK INFORMATION t hit Outlet TANKTO P/L WELL BLDG. d4eli'ttO Air Intake ROAD Dt Inlet Se S y s� t b" NA Dt Bottom Dosing A Header / Man. �f•�� 9� . Aerati NA Dist. Pipe ��lz Holdin Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer De Model Numb GPM TDH I Lift Friction TD Ft Forcemain Length Dia. Dist. To well BSORPTION SYSTEM �'" BlEbk,UENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN I N S DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEA INFORMATION Type C AMBER Mo el N r: Syste 2(0� G� '� � OR DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) _ Y „ x Hole Size x Hole Spacing Vent To Air Intake Length �? Dia. Length COa Dia. Spacing - SC. 14 A 27 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 30.30.19.323C,SE,SE 387 OLD " E " WEST Fihd Plan revision required? ❑ Yes [R /l Use other side for additional information. It C 1 1 � rTGC 64.6,. 7 SBD -6710 (R.3/97) Date Inspector' Signature C �°. Safety and Buildings Division NVISANITARY PERMIT APPLICATION 2 01 E. Washington Ave. s ' consin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 vi x 11 inches in size. ' • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. _ (1� V State Plan I. Num I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Prope Owner Property Location 1 /a 1 /a, S Q T Q, N, R (or& Property Owner's Mai )A Addres Lot Number Block Num r City at Zip Code Phone Number Subdivision Name or CSM, Number Il. TY PE n F BUILDING: (check one) ❑ State Owned E] ity Nearest Road [3 VII age Public W 1 or 2 Family Dwelling - No. of bedrooms IA Town OF Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Num er(s) go. 30.19. 4 25 / - yon 1 [] Apartment / Condo Nn 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. lg Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _____System -------- System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 W Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure �+ �r/ / �� 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day sq. ft.) (Min�nch) Elevation " f �� / Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing structed Tanks Tanks e Ic Ta a -- ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ El VIII. RESPONSIBILITY STATEMENT I, thip undersigned, assume responsibility for inst lation of the onsite sewage system shown on the attached plans. VPlube Na : (P t) Plumber' atur MP /MPRSW No.: Business Phone Number: 3 s- P umber's Address (Street, C tate, ode): IX. COUNTY • / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Is ue Issuing 2&gent g nature (No Stamps) Approved E] Owner Given Initial / urchargeFee) Adverse Determination G <� g / X. CONDITIONS OF APPROVAL/ REASONS FO DISAPPROVAL: rx�g -�c W.A� Ire ("A A <At -4 bit I SBD -6398 (R.11/96) DISTRI ON: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber ,�I - ,[op a�ce.� „�.��s -�Aa ,. ✓/.�wto� f,�ti',o�� - �- ��� �x:y „�r�.�i'7- ,�K.��oJ.�'a - ,i/«.� �v�s�,s �5 � �ittl�• //Dire �s /�SG��,�/ ®u� e o x ® 3 I I { i 7 Wisconsin "Department of Commerce SOIL AND SITE EVALUATION .Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with S. ILHR 83.09, Wis. Adm. Code e!4 Attach complete site plan on paper not less than 8 1/2 x 11 inches n must ounty include, but not limited to: vertical and horizontal reference point (n an percent slope, scale or dimensions, north arrow, and location and � � Cl sar i I D # APPLICANT INFORMATION - Please print all infort��ftion ; ;"98 kevieo by _ Date Personal information you provide may be used for secondary purposes (PH cy Y w, S. 15.0(») .X _ / at /( f Y 1, Property Owner i ! e cation /' Govt. Lot : ;4/4 1/4,S T. N,R Z (or& Property Owner's Mailin ddress Lp4f P14 Subd. Name or CSM# - -- City Sta Zip Code Phone Number ❑ City Village ®T Nearest Road I 1A 17 e ) ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building Replacement / El Public or commercial - Describe: Code derived daily flow Zs gpd Recommended design loading rate i bed, gpd/ft . _� trench, gpd/ft Absorption area required _5" bed, t11 trench, ft Maximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations _ t Parent material T Flood plain elevation, if applicable ft S = Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system © S ❑ U ❑ S ® U ❑ S [Z] U ❑ S M U ❑ S ®U ❑ S 91 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft /f in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench co' � Ground elev. ° " _ Depth to limiting factor Y /S� in. Remarks: Boring # J 7-32 Al Ground - elev. XU_ ft• > Depth to limiting factor Remarks: CST Name (P ase Pr' t� / Signature Telephone No. Address Date CST Number �/ p r /�/s�Ptpl4! f�el ,D�iJ,vu �`lBus� J a �3 Wisconsin rtment of Industry SOIL AND SITE EVALUATION REPORT Pagel of 3 Labor and man Relations Division of fe; & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 030 - 1089 -40 -000 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R k7E B DATE 06 1 IAOZI 7 1 /8 PROPERTY OWNER: PROPERTY LOCATION DAn Scray GOVT. LOT SE 1/4 SE 1/4,S 30 T 30 N,R 19 .1 (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 387 Old E. W. na na na CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Houlton, WI. 54082 (7191 549 -6408 1 St Joseph Old "E" [ ] New Construction Use [ )] Residential / Number of bedrooms 3 [ ] Addition to existing building [x] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate gi bed, gpd /ft trench, gpd /ft Absorption area required 1125 bed, ft 900 trench, ft Maximum design loading rate ._ bed, gpd /ft _,5— trench, gpd /ft Recommended infiltration surface elevation(s) 97.30 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem :K1 S ❑ U CA ❑ U as ❑ U EIS ®U EIS RI U [IS RI U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. 1 0 -6 10yr4 /3 none 1 2msbk mfr cs 2m .5 .6 2 6 -23 10yr4 /4 none sl 2mgr mfr gw lm .5 .6 Ground 3 23 -38 7.5yr4/4 none scl 2csbk mfr gw if .4 .5 elev. 4 38 -84 7.5 r4/4 none sl lcsbk mfr na na .4 .5 1 6 ft. y Depth to limiting factor +84 Remarks: Boring # 1 0 -8 10yr4 /3 none 1 2msbk mfr cs 2m .5 .6 2 <€ 2 8 -17 10yr4 /4 none sil 2msbk mfr gw lm .5 .6 3 17 -37 7.5yr4/4 none sicl 2csbk mfr - - .4 .5 Ground elev. 4 37 -84 7.5yr4/4 none sl lcsbk mfr ; "i:�. i a' ria ,t .5 10 ft. Depth to limiting f ' factor , O ur Remarks: ',` CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave., New RichnaonO, WI 54017 Signature: Date: 6 -17 -98 CST Number: m02298 STEELS SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Dan Scray New Richmond, WI 54017 MPRSW -3254 SE4SE4 S30- T31N -R19w (715) 246 -6200 town of Somerset N 1 =40' BM.= top of cement step @ el. 100 Alt. BM.= top of cement slab in front of garage @ el. 96.40' - 3 � IG 1 a 0 Gary L. Steel 6 -17 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Dan 1 e_ l S arecy Mailing Address _ �S7 ��d W�s� 4 OUL'T�N Wl 54ObZ Property Address _ J nu E we5 :TO(�( "J PL , LL 540Gz Verification required from Planning Department for new construction) City /State � N , yj I Parcel Identification Number bib Iola q —4 k - oob p3v 2 jc� - O'C)d LE GAL DESCR Property Location ZoF ' /a, sf '/1, Sec. �0 , T _N -R W, Town o �OSe�� Subdivision , Lot # Certified Survey Map # Volume , Page # Warranty Deed #. ��� 7a� , Volume , Page # Spec house ❑ yes tA no Lot lines identifiable 1p yes ❑ no SYSTEM MAIN Improper use ; maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping wlt the septic tank every three years or sooner, if needed by a licensed pumper. What y-tt put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journcyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic :,ystcm has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days e thre expir on date. Sldf4ATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on ;his form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty de ribed abov by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** '* Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed